TY  - JOUR
PY  - 2021//
TI  - High mortality and venous thromboembolism risk following major penetrating abdominal venous injuries
JO  - Annals of vascular surgery
A1  - Haqqani, Maha H.
A1  - Levin, Scott R.
A1  - Kalish, Jeffrey A.
A1  - Brahmbhatt, Tejal S.
A1  - Richman, Aaron P.
A1  - Siracuse, Jeffrey J.
A1  - Farber, Alik
A1  - Jones, Douglas W.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - INTRODUCTION: Penetrating injuries to the inferior vena cava (IVC) and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality. <br><br>METHODS: The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality. <br><br>RESULTS: Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P<0.001), concurrent head (P=0.036), spinal cord (P<0.001), and pelvic injuries (P<0.001), and higher total injury severity score (median 20 vs. 8.0, P<0.001). They were more likely to undergo 24-hour hemorrhage control surgery (69% vs. 17%, P<0.001), but less likely to receive VTE chemoprophylaxis during admission (64% vs. 68%, P=0.04). Of patients undergoing iliocaval surgery, 64% underwent repair, 26% ligation, and 10% unknown. Iliocaval injury patients had higher rates of VTE (12% vs. 2%), 24-hour mortality (23% vs. 2.0%) and in-hospital mortality (33% vs. 3.4%) (P<0.001 for all). VTE rates were similar following repair (14%) and ligation (17%). Iliocaval injury patients also had higher rates of cardiac complications (10.3% vs. 1.4%), acute kidney injury (8.2% vs. 1.3%), extremity compartment syndrome (4.0 vs. 0.2%), and unplanned return to OR (7.9% vs. 2.5%) (P<0.001 for all). In multivariable analyses, iliocaval injury was independently associated with risk of VTE (OR 2.12; 95% CI, 1.29-3.48; P = 0.003), and in-hospital mortality (OR = 9.61; 95% CI, 4.96-18.64; P < 0.001). <br><br>CONCLUSION: Iliocaval injuries occur in <5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.<p />  <p>Language: en</p>
LA  - en
SN  - 0890-5096
UR  - http://dx.doi.org/10.1016/j.avsg.2021.06.002
ID  - ref1
ER  -